- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical Utilization Management ... + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management...with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA)… more
- CVS Health (Columbus, OH)
- …day. **Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a field-based/Remote position out of ... independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse ( RN ) with unrestricted...to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and… more
- The Cigna Group (Sacramento, CA)
- …Other duties as required and related to this role. **Minimum requirements:** + Active unrestricted Registered Nurse ( RN ) license in state or territory of the ... to develop models and procedures, and monitor trends, within Nurse Case Management . RN and...Scope:** + Manages/Coordinates an active caseload of inpatient case management cases for Cigna. + Uses clinical … more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... Management reports to the Director of Utilization Management * Oversees clinical ...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- McLaren Health Care (Pontiac, MI)
- …12. Performs other duties as assigned. #LI-KH1 _Required_ + State licensure as a Registered Nurse ( RN ) + Bachelor's degree in nursing from accredited ... needs in EMR for continued communication with ICM UM RN and Care Management staff 7. Assesses..._Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management / clinical … more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management / clinical /or combination; 2 of ... clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is...player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- CVS Health (Carson City, NV)
- …**Must reside in the PST zone** As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate ... **Required Qualifications** - 2 years of experience as a Registered Nurse in adult acute care/critical care... RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will...education, and preventative interventions are maintained. Qualifications: + Active RN license, entry level RN welcome +… more
- Dignity Health (Bakersfield, CA)
- …will require Admin on-call on weekends/holidays.** **Position Summary:** The Supervisor of Utilization Management Inpatient Clinical will oversee clinical ... UM staff, ensuring they effectively perform utilization management (UM) reviews for inpatient cases. This role works...required. - Graduate of an accredited school of nursing: Registered Nursing. - Clear and current CA RN… more